The proposed America's Affordable Health Choices Act of 2009 () was an unsuccessful bill introduced in the U.S. House of Representatives on July 14, 2009. The bill was introduced during the first session of the

111th Congress The 111th United States Congress was a meeting of the legislative branch of the United States federal government from January 3, 2009, until January 3, 2011. It began during the last weeks of the George W. Bush administration, with th ...

as part of an effort of the Democratic Party leadership to enact health care reform. The bill was not approved by the House, but was superseded by a similar bill, the proposed

Affordable Health Care for America Act The Affordable Health Care for America Act (or HR 3962) was a bill that was crafted by the United States House of Representatives of the 111th United States Congress on October 29, 2009. The bill was sponsored by Representative Charles Rangel. ...

(HR 3962), which was passed by the House in November 2009, by a margin of 220-215 votes but later abandoned. A similar bill to HR 3200, called the "Affordable Health Choices Act" (HR 1679), was introduced in the

Senate A senate is a deliberative assembly, often the upper house or chamber of a bicameral legislature. The name comes from the ancient Roman Senate (Latin: ''Senatus''), so-called as an assembly of the senior (Latin: ''senex'' meaning "the el ...

on September 17, 2009. It too was unsuccessful as the Senate approved instead another proposal called the "

Patient Protection and Affordable Care Act The Affordable Care Act (ACA), formally known as the Patient Protection and Affordable Care Act and colloquially known as Obamacare, is a landmark U.S. federal statute enacted by the 111th United States Congress and signed into law by Pres ...

". According to the

Congressional Budget Office The Congressional Budget Office (CBO) is a List of United States federal agencies, federal agency within the United States Congress, legislative branch of the United States government that provides budget and economic information to Congress. Ins ...

, HR 3200 included tax increases and spending cuts that reduce the net increase in the federal deficit to 1% of 2008 tax revenues. The CBO director subsequently noted that, in terms of total National Health Expenditure, non-governmental spending will increase as coverage expands. The bill was originally sponsored by Representatives

John Dingell John David Dingell Jr. (July 8, 1926 – February 7, 2019) was an American politician who served as a member of the United States House of Representatives from 1955 until 2015. A member of the Democratic Party, he holds the record for longes ...

Charles Rangel Charles Bernard Rangel (, ; born June 11, 1930) is an American politician who was a U.S. representative for districts in New York from 1971 to 2017. A member of the Democratic Party, he was the second-longest serving incumbent member of the Ho ...

Henry Waxman Henry Arnold Waxman (born September 12, 1939) is an American politician who served as a U.S. representative from California from 1975 to 2015. He is a member of the Democratic Party. His district included much of the western part of the city of ...

, George Miller,

Pete Stark Fortney Hillman Stark Jr. (November 11, 1931 – January 24, 2020), known as Pete Stark, was an American businessman and politician who was a member of the United States House of Representatives from 1973 to 2013. A Democrat from California, S ...

Frank Pallone Frank Joseph Pallone Jr. (; born October 30, 1951) is an American lawyer and politician serving as the U.S. representative for , serving since 1988. He is a member of the Democratic Party. The district, numbered as the 3rd district from 1988 to ...

, and Robert Andrews. The 1017 page PDF version of the bill is the first of three health care reform-related legislative proposals expected from the Democratic congressional leadership.Marianne Kolbasuk McGe
Health Care Overhaul Bill Calls For Online Enrollment
InformationWeek June 10, 2009 Votes in the U.S. House of Representatives on this bill and on the

Medicare for All Act The Medicare for All Act, aka the Expanded and Improved Medicare for All Act or United States National Health Care Act, is a bill first introduced in the United States House of Representatives by Representative John Conyers (D-MI) in 2003, with ...

, an alternative that would establish a national, universal

single-payer health insurance Single-payer healthcare is a type of universal healthcare in which the costs of essential healthcare for all residents are covered by a single public system (hence "single-payer"). Single-payer systems may contract for healthcare services from p ...

, were previously expected in September 2009 and again in October 2009, before the actual November 2009 vote took place.

Elements of the bill

The summary of the bill includes the following elements, among others: #Establishes a mandate to purchase private insurance for most individuals with an income above poverty level. #Creates a mechanism to enforce the mandate in a sliding scale tax on those who do not purchase health insurance for most legal United States residents with an income above poverty level. # Prohibits

pre-existing condition In the context of healthcare in the United States, a pre-existing condition is a medical condition that started before a person's health insurance went into effect. Before 2014, some insurance policies would not cover expenses due to pre-existi ...

exclusions. #Requires adjusted community rating, guaranteed issue, and guaranteed renewal of individual and small group health insurance that: ''limits'' age rating variation of premiums to 2:1 (200 percent), ''prohibits'' gender and health status rating variation of premiums, ''allows'' variation of premiums by geographic area and family (vs. individual) enrollment. #Prohibits cancellation of coverage except for evidence of fraud. #Limits annual out-of-pocket expenses to $5,000 for an individual and $10,000 for a family. #Requires Health and Human Services to create a non-subsidized public health insurance plan with pricing based on private industry averages. Three optional levels of coverage are to be offered by the plan which must set premiums at a level sufficient to fully finance the costs of the health benefits the administrative costs related to operating the plan. #Establishes a Health Insurance Exchange (HIE) within a proposed Health Choices Administration, to provide a market place for insurers to sell qualifying plans on a public web site. s:H.R. 3200/Division A/Title II/Subtitle A #Requires the creation of a

risk equalization Risk equalization is a way of equalizing the risk profiles of insurance members to avoid loading premiums on the insured to some predetermined extent. In health insurance, it enables private health insurance to operate in some countries to be offer ...

pool that will allow qualifying plans to minimize the impact of

adverse selection In economics, insurance, and risk management, adverse selection is a market situation where buyers and sellers have different information. The result is that participants with key information might participate selectively in trades at the expe ...

of enrollees among the plans. #Provides a

tax credit A tax credit is a tax incentive which allows certain taxpayers to subtract the amount of the credit they have accrued from the total they owe the state. It may also be a credit granted in recognition of taxes already paid or a form of state "dis ...

for

low-income Poverty is the state of having few material possessions or little

income

individuals and families to help pay insurance premiums. #Requires employers with payroll costs over $500,000 to provide health insurance that meets the minimum standard of coverage allowed in the HIE. # Provides for a tax on employers that do not provide the required health insurance. # Provides for a tax on couples with adjusted joint gross income exceeding $350,000 (80% of this figure for single people) #Reduces Medicare payments to hospitals with excessive re-admissions. #Further expands Medicaid eligibility and scope of covered preventive services, for lower-income individuals and families. #Increases Medicaid payments to physicians for primary care. # Provides for a phased-in elimination of the

Medicare Part D Medicare Part D, also called the Medicare prescription drug benefit, is an optional United States federal-government program to help Medicare beneficiaries pay for self-administered prescription drugs. Part D was enacted as part of the Medica ...

coverage gap and requires drug manufactures to discount and/or rebate additional qualifying drugs originally excluded from the plan. #Requires the Secretary of

Health and Human Services The United States Department of Health and Human Services (HHS) is a cabinet-level executive branch department of the U.S. federal government created to protect the health of all Americans and providing essential human services. Its motto is ...

(HHS) to develop quality measures for the delivery of health care services in the United States. # Establishes the Health Benefits Advisory Committee chaired by the

Surgeon General of the United States The surgeon general of the United States is the operational head of the United States Public Health Service Commissioned Corps (PHSCC) and thus the leading spokesperson on matters of public health in the federal government of the United States. T ...

. # Prioritizes any eventual implementation of best practices in the delivery of health care. # Establishes a National Prevention and Wellness Strategy along with appropriations for its trust fund. #

Outlines Outline or outlining may refer to: * Outline (list), a document summary, in hierarchical list format * Code folding, a method of hiding or collapsing code or text to see content in outline form * Outline drawing, a sketch depicting the outer edg ...

Administrative standards that reduces costs and improves service, including the ability for Administrators to determine an accurate total financial estimate at the point of service as well as enabling real time electronic transfer of funds to take place if possible (mirror
currently existing laws
.

House Committees' mark-ups

America's Affordable Health Choices Act of 2009 has been amended in the nature of substitute during mark-up proceedings since its original introduction recorded in the Congressional Record on July 14, 2009. These amendments have only been voted on by each Committee involved in order to pass out of the Committee phase but have not been voted on by the full House membership, which is needed before the originally introduced legislation can be changed to reflect any amendments recommended by the Committees and passed by a full House vote.

House Committee on Energy and Commerce

* See external link t
Mark-Up Summary

House Committee on Ways and Means

:* See external link t
Mark-Up Summary

House Committee on Education and Labor

:* Kucinich Amendment :: The Kucinich Amendment to Health Care Bill HR 3200 grants

states rights In American political discourse, states' rights are political powers held for the state governments rather than the federal government according to the United States Constitution, reflecting especially the enumerated powers of Congress and the ...

to single payer health care at the state level. This is how

Canada Canada is a country in North America. Its ten provinces and three territories extend from the Atlantic Ocean to the Pacific Ocean and northward into the Arctic Ocean, covering over , making it the world's second-largest country by to ...

adopted single payer, with

Saskatchewan Saskatchewan ( ; ) is a Provinces and territories of Canada, province in Western Canada, western Canada, bordered on the west by Alberta, on the north by the Northwest Territories, on the east by Manitoba, to the northeast by Nunavut, and on t ...

passing it first. In July 2009, the House Education and Labor Committee approved the Kucinich Amendment by a vote of 27–19, with 14 Democrats and 13 Republicans voting for it. :* See external link t
Mark-Up Summary

Comparison with Senate versions

The Washington Post ''The Washington Post'' (also known as the ''Post'' and, informally, ''WaPo'') is an American daily newspaper published in Washington, D.C. It is the most widely circulated newspaper within the Washington metropolitan area and has a large n ...

'' published comparison tables of the main House version with the two main Senate versions, which themselves may be summarized as:

CBO analysis of the bill

The U.S.

is a non-partisan organization that analyzes the effect on the federal budget of proposed and existing legislation on behalf of the Congress. CBO analyzed the bill as of July 14, 2009 and reported the following: In terms of what would happen for consumers, the CBO's methodology in a report in late July used a public plan with premiums about 10% lower than private plans.

Health exchange details

Businesses with ten or fewer employees can use the exchange in the first year after the act begins. The cutoff changes to twenty or fewer employees the next year. On the third year, the 'Health Choices Commissioner' has the authority to phase in businesses with more employees. The legislation does not specify any further phases, leaving that up to the officer to decide.Weiner mangles details of health care reform

PolitiFact PolitiFact.com is an American nonprofit project operated by the Poynter Institute in St. Petersburg, Florida, with offices there and in Washington, D.C. It began in 2007 as a project of the ''Tampa Bay Times'' (then the ''St. Petersburg Times ...

. Retrieved August 30, 2009. The act creates new standards, intended by lawmakers as methods of

consumer protection Consumer protection is the practice of safeguarding buyers of goods and services, and the public, against unfair practices in the marketplace. Consumer protection measures are often established by law. Such laws are intended to prevent business ...

, for what would be considered a minimally acceptable insurance plan. Employers that currently offer insurance have a five-year grace period after the act begins before they would be subject to the standards. Individuals would be free to purchase their own private insurance, or work with the public option, in this period and afterward.

Health Benefits Advisory Committee

According to Division A, Title I, Subtitle C, Section 123 of HR 3200, a Health Benefits Advisory Committee shall be established to be chaired by the

. It will consist of 9 more individuals who are not federal employees that are appointed by the

President of the United States The president of the United States (POTUS) is the head of state and head of government of the United States of America. The president directs the Federal government of the United States#Executive branch, executive branch of the Federal gove ...

. It will also consist of 9 members who are appointed by the

Comptroller General of the United States The Comptroller General of the United States is the director of the Government Accountability Office (GAO, formerly known as the General Accounting Office), a legislative-branch agency established by Congress in 1921 to ensure the fiscal and man ...

. Also, up to eight more members will be appointed in even numbers by the

who are federal employees and officers. Each member of the committee will serve three year terms. The Health Benefits Advisory Committee will recommend to the

United States Secretary of Health and Human Services The United States secretary of health and human services is the head of the United States Department of Health and Human Services, and serves as the principal advisor to the president of the United States on all health matters. The secretary is ...

benefit standards and periodic updates to such standards.

Debate and controversies

Reimbursement for counseling about living wills

One often-cited provision of the un-passed bill would have authorized Medicare reimbursement for physicians who provide voluntary counseling about such subjects as living wills. The provision is based on a separate bill that was cosponsored by

Republican Republican can refer to: Political ideology * An advocate of a republic, a type of government that is not a monarchy or dictatorship, and is usually associated with the rule of law. ** Republicanism, the ideology in support of republics or agains ...

Charles Boustany Charles William Boustany Jr. (; born February 21, 1956) is an American politician, physician, and former congressman from Lafayette, Louisiana, who served as the U.S. representative from Louisiana's 3rd congressional district from 2005 to 2017 (nu ...

Louisiana Louisiana , group=pronunciation (French: ''La Louisiane'') is a state in the Deep South and South Central regions of the United States. It is the 20th-smallest by area and the 25th most populous of the 50 U.S. states. Louisiana is bord ...

, a surgeon, and is similar to end-of-life counseling signed by President George W. Bush. This Advance Care Planning Consultation section was criticized by some Republicans and

conservatives Conservatism is a cultural, social, and political philosophy that seeks to promote and to preserve traditional institutions, practices, and values. The central tenets of conservatism may vary in relation to the culture and civilization in ...

such as

Betsy McCaughey Elizabeth Helen McCaughey (; née Peterken; born October 20, 1948), formerly known as Betsy McCaughey Ross, is an American politician who was the Lieutenant Governor of New York from 1995 to 1998, during the first term of Governor George Pataki. ...

, a

lobbyist In politics, lobbying, persuasion or interest representation is the act of lawfully attempting to influence the actions, policies, or decisions of government officials, most often legislators or members of regulatory agencies. Lobbying, which ...

for the

healthcare industry The healthcare industry (also called the medical industry or health economy) is an aggregation and integration of sectors within the economic system that provides goods and services to treat patients with curative, preventive, rehabilitative, ...

who also helped to defeat the

Clinton health care plan of 1993 The Clinton health care plan was a 1993 healthcare reform package proposed by the administration of President Bill Clinton and closely associated with the chair of the task force devising the plan, First Lady of the United States Hillary Clinto ...

. These critics allege that it includes mandatory language aimed at pressing elderly and disabled patients toward

euthanasia Euthanasia (from el, εὐθανασία 'good death': εὖ, ''eu'' 'well, good' + θάνατος, ''thanatos'' 'death') is the practice of intentionally ending life to eliminate pain and suffering. Different countries have different eut ...

. Their interpretation was the basis for the charge about this section by prominent Republican 2008 Vice Presidential candidate

Sarah Palin Sarah Louise Palin (; Heath; born February 11, 1964) is an American politician, commentator, author, and reality television personality who served as the ninth governor of Alaska from 2006 until her resignation in 2009. She was the 2008 R ...

. However, the "level of productivity in society" or panels claim is not mentioned in the actual legislation, which is structured primarily to amenda specific clause
in the Social Security Act, Section 1861 of definitions that are used in sections regarding reimbursements for end-of-life counseling, including the use of

Advance Directive An advance healthcare directive, also known as living will, personal directive, advance directive, medical directive or advance decision, is a legal document in which a person specifies what actions should be taken for their health if they are no ...

s. Charles Boustany's Democratic cosponsor,

Earl Blumenauer Earl Francis Blumenauer ( ; born August 16, 1948) is an American lawyer, author, and politician serving as the U.S. representative for since 1996. The district includes most of Portland east of the Willamette River. A member of the Democrat ...

of Oregon, has called this attack on the bill "an all-time low". Blumenauer said the measure would block funds for counseling that presents suicide or assisted suicide as an option, and called references to death panels or euthanasia "mind-numbing". He said that "the majority of Congressional Republicans supported the similar provisions for terminally ill elderly patients that were part of the 2003 prescription drug bill" and that, out of the dozens of Republican proposals for revising the bill, "not a single word" was said against end-of-life counseling. He said that

Rush Limbaugh Rush Hudson Limbaugh III ( ; January 12, 1951 – February 17, 2021) was an American conservative political commentator who was the host of '' The Rush Limbaugh Show'', which first aired in 1984 and was nationally syndicated on AM and FM r ...

Virginia Foxx Virginia Ann Foxx ( Palmieri;Foxx, Virginia Ann
. ''Biographical Directory of ...

Newt Gingrich Newton Leroy Gingrich (; né McPherson; born June 17, 1943) is an American politician and author who served as the 50th speaker of the United States House of Representatives from 1995 to 1999. A member of the Republican Party, he was the U. ...

Charles Grassley Charles Ernest Grassley (born September 17, 1933) is an American politician serving as the president pro tempore emeritus of the United States Senate, and the senior United States senator from Iowa, having held the seat since 1981. In 2022, he ...

and other Republicans defended the death panel story only after Betsy McCaughey's editorials, and that some people at town hall meetings even wanted to "keep government out of their Medicare," a government run program. Blumenauer said that as recently as April 2008 then-governor Palin supported end-of-life counseling as part of Health Care Decisions Day. Palin's office called this comparison "hysterically funny" and "desperate".Eric Adams, September 14, 2009, MSNBC
Blumenauer's end-of-life counseling once favored by Palin
Republican Senator

Johnny Isakson John Hardy Isakson (December 28, 1944 – December 19, 2021) was an American businessman and politician who served as a United States senator from Georgia from 2005 to 2019 as a member of the Republican Party. He represented in the United States ...

, who co-sponsored a 2007 end-of-life counseling provision, called the euthanasia claim "nuts". Analysts who examined the end-of-life provision Palin cited agreed that it merely authorized Medicare reimbursement for physicians who provide voluntary counseling for advance health care directives (including living wills).PolitiFact, August 7, 2009
Sarah Palin falsely claims Barack Obama runs a 'death panel'
/ref> According to TIME and ABC, Palin and McCaughey made false euthanasia claims.ABC News, Jake Tapper, August 7, 2009
Palin Paints Picture of 'Obama Death Panel' Giving Thumbs Down to Trig
The page 425 legislation began as a separate bill that was co-sponsored by Republicans

Patrick Tiberi Patrick Joseph Tiberi (; born October 21, 1962) is an American lobbyist and politician who served as the U.S. representative for from 2001 to 2018. His district included communities north and east of Columbus. He is a member of the Republican ...

and

Geoff Davis Geoffrey Clark Davis (born October 26, 1958) is an American businessman, politician and former U.S. Representative for , serving from 2005 to 2012. He is a member of the Republican Party. The district includes 24 counties in the northeastern par ...

. Boustany, a heart surgeon, said the end-of-life legislation was a "good medical practice". 204 GOP House members and 42 GOP Senators voted for a 2003 Medicare prescription drug bill that included end-of-life counseling. The 2003 legislation only covered end-of-life counseling for terminally ill patients, which the Republican

supported. Grassley said that the 2009 end-of-life counseling would " pull the plug on grandma" and that "You shouldn't have counseling at the end of life, you should have done that 20 years before," which is what the 2009 legislation would allow. Republican

defended the death panel claim, but previously praised the Gundersen Lutheran Health System for encouraging the widespread use of Advance Directives. The federal requirement that hospitals help patients with things like living wills began when Republican George H. W. Bush was president.Ricardo Alonso-Zaldivar, August 15, 2009, AP
Palin is wrong: There's no 'death panel' in health care bill
Section 1233 merely allows doctors to be paid for their time. However, between 30 percent and 45 percent of Americans believed in the death panel story. According to PolitiFact, private health insurance companies already ration health care by income, by denying health insurance to those with pre-existing conditions and by caps on health insurance payments.

Rationing Rationing is the controlled distribution of scarce resources, goods, services, or an artificial restriction of demand. Rationing controls the size of the ration, which is one's allowed portion of the resources being distributed on a particular ...

exists now, and will continue to exist with or without health care reform.PolitiFact
There's rationing in health care now, and there still would be under reform bill
/ref> The "death panel" argument was endorsed by an erroneous editorial in the ''

Investor's Business Daily ''Investor's Business Daily'' (''IBD'') is an American newspaper and website covering the stock market, international business, finance and economics. Founded in 1984 by William O'Neil as a print news publication, it is owned by News Corp and is ...

'', which analogized the bill to the

National Health Service The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...

(NHS) in the

United Kingdom The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain, is a country in Europe, off the north-western coast of the continental mainland. It comprises England, Scotland, Wales and ...

and editorialized: "People such as scientist Stephen Hawking wouldn't have a chance in the U.K., where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless." The Investor's Business Daily editorialists had to beat a retreat and quickly retracted its claim after it was pointed out that Hawking was in fact British, and had lived his entire life in the United Kingdom with treatment from the NHS. Stephen Hawking responded, "I wouldn't be here today if it were not for the NHS. I have received a large amount of high-quality treatment without which I would not have survived." On a separate issue, physician and conservative commentator

Charles Krauthammer Charles Krauthammer (; March 13, 1950 – June 21, 2018) was an American political columnist. A moderate liberal who turned independent conservative as a political pundit, Krauthammer won the Pulitzer Prize for his columns in '' The Washingt ...

has criticized what he sees as a naive focus on living wills by the policymakers over other types of medical advice. He has written:

Competition

A CNN report has stated that the proposed public option is a '

lightning rod A lightning rod or lightning conductor (British English) is a metal rod mounted on a structure and intended to protect the structure from a lightning strike. If lightning hits the structure, it will preferentially strike the rod and be conducte ...

' in American public opinion about healthcare reform. Republicans, people with the insurance industry, and employer groups have discussed the concern that the availability of a public plan would make it difficult for private insurers to compete. This may then lead to a situation where most people end up being covered by the public insurance option. The

's analysis in late July stated that this would not be the case for the "

public option The public health insurance option, also known as the public insurance option or the public option, is a proposal to create a government-run health insurance agency that would compete with other private health insurance companies within the United ...

" included in H.R. 3200, projecting that only about 11 to 12 million people would enroll in the public option. The Lewin Group, a research firm that is part of a subsidiary of

UnitedHealth Group UnitedHealth Group Incorporated is an American multinational managed healthcare and insurance company based in Minnetonka, Minnesota. It offers health care products and insurance services. UnitedHealth Group is the world's seventh largest ...

but is run independently, has estimated that over 100 million people would join the public plan if it were structured like Medicare, which would then make it the dominant insurer. A model similar to one proposed by the late Senator

Ted Kennedy Edward Moore Kennedy (February 22, 1932 – August 25, 2009) was an American lawyer and politician who served as a United States senator from Massachusetts for almost 47 years, from 1962 until his death in 2009. A member of the Democratic ...

would bring in between 21.5 million and 67.5 million according to the group. A 2008 report by the

Urban Institute The Urban Institute is a Washington, D.C.–based think tank that carries out economic and social policy research to "open minds, shape decisions, and offer solutions". The institute receives funding from government contracts, foundations and pr ...

stated the public option would probably settle into a '

niche Niche may refer to: Science *Developmental niche, a concept for understanding the cultural context of child development * Ecological niche, a term describing the relational position of an organism's species *Niche differentiation, in ecology, the ...

' in the insurance market with other firms still able to compete. The bill bases the publicly authorized insurance plan fees on industry averages, so there is no clear economic competitive advantage versus existing private insurance. The health insurance subsidy is available to anyone with a qualifying level of income buying insurance from the exchange regardless of whether they choose a public or private plan. A poll done by ''Penn, Schoen and Berland Associates'' for the

AARP AARP (formerly called the American Association of Retired Persons) is an interest group in the United States focusing on issues affecting those over the age of fifty. The organization said it had more than 38 million members in 2018. The magazi ...

stated that only 37% of Americans correctly identified the definition of the 'public option' being proposed, numbers very close to respondents guessing randomly among answers. In a June 2009

NBC News NBC News is the news division of the American broadcast television network NBC. The division operates under NBCUniversal Television and Streaming, a division of NBCUniversal, which is, in turn, a subsidiary of Comcast. The news division's v ...

The Wall Street Journal ''The Wall Street Journal'' is an American business-focused, international daily newspaper based in New York City, with international editions also available in Chinese and Japanese. The ''Journal'', along with its Asian editions, is published ...

survey, 76% said it was either "extremely" or "quite" important to "give people a choice of both a public plan administered by the federal government and a private plan for their health insurance." A July survey by Rasmussen Reports found 50% of Americans opposed the idea of a public option and 35% expressed support. An August 2009 NBC News/Wall Street Journal poll found 47% of Americans opposed and 43% expressing support. CNN Polling Director Keating Holland has stated that partisan affiliations drive people's opinions on the issue.Poll: Americans split on public option
By Paul Steinhauser. CNN. Posted August 18, 2009. Retrieved September 1, 2009.

Town halls

A number of

town hall meeting Town hall meetings, also referred to as town halls or town hall forums, are a way for local and national politicians to meet with their constituents either to hear from them on topics of interest or to discuss specific upcoming legislation or ...

s held by members of Congress during the August 2009 congressional recess were the site of protests and disruptions by opponents of this health care reform legislation. Steven Pearlstein of ''

'' wrote that the concerns raised in most of these town hall disruptions are factually incorrect claims made by some conservative members of Congress and some in the

right-wing Right-wing politics describes the range of Ideology#Political ideologies, political ideologies that view certain social orders and Social stratification, hierarchies as inevitable, natural, normal, or desirable, typically supporting this pos ...

media in opposition of the reform bill. Wendell Potter, who has been an executive of

Cigna Cigna is an American multinational managed healthcare and insurance company based in Bloomfield, Connecticut. Its insurance subsidiaries are major providers of medical, dental, disability, life and accident insurance and related products and se ...

, a for-profit health insurer, stated that health insurance companies "are very much behind the town hall disruptions that you see and a lot of the deception that's going on in terms of disinformation that many Americans, apparently, are believing." Many proponents of the reform bill have accused organizations such as

FreedomWorks FreedomWorks is a conservative and libertarian advocacy group based in Washington, D.C. FreedomWorks trains volunteers, assists in campaigns, and encourages them to mobilize, interacting with both fellow citizens and their political representat ...

, a corporate and individual funded activist group, of organizing these protests to look like grassroots opposition. FreedomWorks representatives have stated that they represent grassroots dissatisfaction and disputed the allegations. The chairman of FreedomWorks is former Republican

House Majority Leader Party leaders of the United States House of Representatives, also known as floor leaders, are congresspeople who coordinate legislative initiatives and serve as the chief spokespersons for their parties on the House floor. These leaders are e ...

and healthcare lobbyist

Dick Armey Richard Keith Armey (; born July 7, 1940) is an American economist and politician. He was a U.S. Representative from Texas's (1985–2003) and House Majority Leader (1995–2003). He was one of the engineers of the "Republican Revolution" of t ...

. Health Care for America Now (HCAN), a union and individual-funded liberal activist group, organized and co-ordinated health care reform proponents in the town hall meetings. FreedomWorks has accused them of

astroturfing Astroturfing is the practice of masking the sponsors of a message or organization (e.g., political, advertising, religious or public relations) to make it appear as though it originates from and is supported by grassroots participants. It is a ...

, which HCAN disputes. The

Service Employees International Union Service Employees International Union (SEIU) is a labor union representing almost 1.9 million workers in over 100 occupations in the United States and Canada. SEIU is focused on organizing workers in three sectors: healthcare (over half of members ...

(SEIU), a labor union, has been accused by opponents of the reform bill of busing paid operatives into town halls to demonstrate in support of the measure. The group denies the accusation. Rasmussen Reports found in a late-August survey that a 49% plurality of Americans believe that protesters genuinely express their own views while 37% consider them to be a creation of special interest groups and lobbyists. An early-August survey stated that 35% viewed the protests unfavorably and 41% viewed them favorably. Both polls showed highly partisan differences in people's view of the town halls.

Medicare issues

Ezra Klein Ezra Klein (born May 10, 1984) is an American journalist, political analyst, ''New York Times'' columnist, and the host of ''The Ezra Klein Show'' podcast. He is a co-founder of '' Vox'' and formerly served as the website's editor-at-large. He h ...

has written in ''

' in late August that, in his opinion, polls now indicate that senior citizens are becoming fearful of healthcare reform, due to concerns that funding subsidies for the uninsured would require cuts to the popular Medicare program. He said that the specific changes "don't involve anything of the kind (most of the savings would come from reducing overpayments to the private insurers that participate in the Medicare Advantage program)". He argued that, as a result, an odd but potent political alliance has emerged with Republicans arguing to protect the existing Medicare program despite its position historically which has been to oppose Medicare as an entitlement. Peter R. Orszag, the then director of the CBO, argued in June 2008 that the Medicare program as currently structured is unsustainable without significant reform, as tax revenues dedicated to the program are not sufficient to cover its rapidly increasing expenditures. According to the CBO, spending on Medicare will grow from $485 billion during 2009 to $879 billion by 2018. President Obama said at a White House news conference on July 22 that, without changes, the system is guaranteed "to basically break the federal budget". He argued that it is necessary to cut wasteful spending which is known to exist (over-testing, no IT, lack of co-ordination, hospital re-admissions) in order to cut costs in order to protect Medicare in the future and cut the projected national deficit. The act, as currently structured, does not cut present Medicare benefits. It reduces projected future increases in Medicare spending such as inpatient hospital service payments and ambulatory care payments that would otherwise undergo annual re-adjustments. These changes would save $196 billion from Medicare over 10 years and removing wasteful subsidies to insurers for Medicare Advantage plan would save a further $156 billion according to the CBO.

Gail Wilensky Gail R. Wilensky (born June 14, 1943) is an American health economist who has worked for Republican administrations and candidacies. Life Wilensky headed Medicare under the first president Bush and works at Project HOPE Project HOPE (Heal ...

, a deputy assistant to President Bush Snr advising him on health and welfare issues from 1992 to 1993 and previously a director of Medicare and Medicaid has expressed concern that this might affect seniors access to health care if the changes are made too quickly, while other activists such as Stuart Guterman of the

Commonwealth Fund The Commonwealth Fund is a private U.S. foundation whose stated purpose is to "promote a high-performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society's most vulnerable, includ ...

argue that Medicare Advantage plans cost the taxpayer $1,000 per policyholder more than if the person had been insured through traditional fee for services.

Illegal immigrants

HR 3200 states that illegal immigrants are not eligible for the proposed taxpayer-funded affordable premium credits. Republicans have stated that there is nothing in the bill to enforce this. A group of 21 House Democrats, led by Rep. Michael M. Honda, are trying to change those requirements. He has argued that the restriction "will only add to uncompensated care costs and costly emergency room visits. Costs due to such visits will be shifted and distributed among all those who have been mandated to carry insurance. With skyrocketing health care costs, legislators should do all that we can to contain costs for working American families".http://www.house.gov/apps/list/press/ca15_honda/Health_090923.html Text of letters from Rep. Honda and leaders within the Congressional Tri-Caucus, the Congressional Progressive Caucus (CPC), and other Members of Congress to key players in the reform debate in the House of Representatives and the Senate. The

Center for Immigration Studies The Center for Immigration Studies (CIS) is an anti-immigration think tank and a SPLC designated hate group. It favors far lower immigration numbers, and produces analyses to further those views. The CIS was founded by historian Otis L. Graha ...

has also commented on the issue.

Abortion funding

The

Hyde Amendment In U.S. politics, the Hyde Amendment is a legislative provision barring the use of federal funds to pay for abortion, except to save the life of the woman, or if the pregnancy arises from incest or rape. Before the Hyde Amendment took effect in ...

prohibits federal funding for abortions in government related health programs unless they are performed in cases of rape, incest, or to save the life of the mother. A political controversy has broken out about whether or not the 'public plan' in HR 3200 will cover abortions, which, if done, would be funded by premiums paid by individuals to that agency and not by outside payments. After rejecting Democratic Rep.

Lois Capps Lois Ragnhild Capps (née Grimsrud; January 10, 1938) is an American politician who served as the U.S. representative for from 1998 to 2017. She is a member of the Democratic Party. The district, numbered as the 22nd District from 1998 to 2003 ...

's amendment to segregate abortion funding, the House or Representatives voted for tighter restrictions on federal funding for elective abortions via the Stupak Amendment.

Ad campaign funding

"America's Health Insurance Plans", a lobbyist group, opposed the bill. 'Americans for Stable Quality Care' is an activist group that has devised television ads in support of this type of healthcare reform. Although the group gets funding from the drug lobby

PhRMA Pharmaceutical Research and Manufacturers of America (PhRMA, pronounced ), formerly known as the Pharmaceutical Manufacturers Association, is a trade group representing companies in the pharmaceutical industry in the United States. Founded in 19 ...

as well as from the

, it does not disclose this fact in the ads themselves. The head of the

Public Relations Society of America The Public Relations Society of America (PRSA) is a nonprofit trade association for public relations professionals. It was founded in 1947 by combining the American Council on Public Relations and the National Association of Public Relations C ...

, Michael Cherenson, has accused the group of dishonest '

front group A front organization is any entity set up by and controlled by another organization, such as intelligence agencies, organized crime groups, terrorist organizations, secret societies, banned organizations, religious or political groups, advocacy gr ...

' manipulations (his group does not use the exact term '

' since it respects the trademark). The vice chairperson of

has disputed the allegation and referred to the campaign as completely "transparent".

References

External links

H.R.3200 America's Affordable Health Choices Act of 2009 from the Library of Congress

as originally introduced in the House from GPO's FDsys. * Additional Committee documentation since the introduction of H.R. 3200 in Congress (July 14, 2009): *
House Committee on Energy and Commerce
*
House Committee on Ways & Means
*
House Committee on Education & Labor
* President Obam
REMARKS BY THE PRESIDENT TO A JOINT SESSION OF CONGRESS ON HEALTH CARE
September 9, 2009
Capps amendment to H.R. 3200
House Energy and Commerce Committee. 30 Jul 2009. {{DEFAULTSORT:America's Affordable Health Choices Act Of 2009 Proposed legislation of the 111th United States Congress Healthcare reform legislation in the United States United States proposed federal health legislation